中国成人HIV/AIDS病人抗病毒治疗失访情况及其影响因素分析

Study on loss to follow-up from antiretroviral therapy among adult HIV-infected individuals in China

目的了解中国成人艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)抗病毒治疗失访比例及其影响因素。方法对全国免费抗病毒治疗库中,2012年1月1日至12月31日开始抗病毒治疗的HIV/AIDS病人失访情况进行随访,随访截止到2014年12月31日。采用Cox比例风险模型分析队列失访率及其影响因素。结果共有26 742名HIV感染者进入队列。12个月的累积失访率为7.6/100人年,24个月的累积失访率为10.5/100人年。Cox比例风险模型多因素分析显示,基线高CD4+T淋巴细胞组、注射吸毒、异性性传播以及初始治疗方案为齐多夫定/司坦夫定+拉米夫定+依非韦伦/奈韦拉平与较高的失访率相关(P<0.05)。结论应该重点强化注射吸毒HIV/AIDS病人的干预措施,加强对高基线CD4+T淋巴细胞HIV/AIDS病人感染者的医疗咨询,对治疗药物有不良反应的病人要及时处理或更换治疗方案。

Objective To understand the proportion of loss to follow-up and associated factors among people living with HIV/AIDS（PLHIV）in China.Methods PLHIV initiating antiretroviral therapy between January 1st,2012 and December 31 st,2012were selected and followed up until December 31 st,2014.Cox proportional hazards regression was used to describe and analyze the loss to follow-up and associated factors.Results The cumulative probability of loss to follow-up among PLHIV in China was 7.6/100person-years after 12 months of initiating ART,and 10.5/100person-years after 24 months of initiating ART.Results from the cox regression model indicated that loss to follow-up was significantly associated with factors as CD4 cell count≥500cells/μl,injection drug use,heterosexual individuals and initial ART regime consisting of AZT/d4T＋3TC＋EFV/NVP.Conclusion We should strengthen the medical consultation for PLHIV with high baseline CD4 and the intervention measures for injecting drug users.In addition,patients with serious adverse drug reactions should switch treatment regime timely.